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目的研究增生性糖尿病视网膜病变(PDR)合并纤维血管膜患者行膜分割和膜清除两种手术方法的临床效果。方法对1996-2000年行玻璃体手术的276例(296只眼)PDR患者的连续临床资料进行回顾性分析。严格选择术后随访时间超过4个月者,硅油填充眼必须是在取出硅油后超过3个月者。所有患者的视网膜上均有纤维血管膜,201只眼合并不同程度的玻璃体积血,101只眼合并不同程度的牵拉性视网膜脱离。在玻璃体手术中,110只眼采用膜分割方法,186只眼采用膜清除方法。比较“膜分割”与“膜清除”两组患者术中医源性视网膜裂孔、术后玻璃体积血及术后视力>0.1的发生率。并对膜分割和膜清除组中采用同一种填充物眼的疗效进行比较。结果两组患者的性别、年龄及病变分型比较,差异无显著意义(P>0.05)。膜分割组患者视网膜裂孔发生率(35.5％)低于膜清除组(54.3％),而术后视网膜再出血率和术后视力的改善率在两种手术方法间差异无显著意义(P>0.05)。结论膜分割组患者术中形成视网膜裂孔的风险小,术后出血的发生率稍低于膜清除组;两组患者术后视力改善率差异无显著意义(P>0.05)。建议初学者行PDR玻璃体手术时应从膜分割起步。(中华眼科杂志,2004,40:439-442)
Objective To study the clinical effect of two methods of operation of membrane division and membrane clearance in patients with proliferative diabetic retinopathy (PDR) and fibroplasmic membrane. Methods The clinical data of 276 patients (296 eyes) with PDR undergoing vitrectomy from 1996 to 2000 were analyzed retrospectively. Strict selection of postoperative follow-up for more than 4 months, silicone oil filled eyes must be in the removal of silicone oil more than 3 months. All patients had fibrin membrane on the retina, 201 eyes combined with varying degrees of vitreous hemorrhage, 101 eyes combined with varying degrees of traction retinal detachment. In vitreous surgery, 110 eyes were treated by membrane fractionation and 186 eyes were treated by membrane depletion. The incidence of iatrogenic retinal tears, postoperative vitreous hemorrhage and postoperative visual acuity> 0.1 were compared between the two groups of “membrane segmentation” and “membrane clearance”. The effects of using the same filler eye in the segmenting and membrane-clearing groups were compared. Results There was no significant difference in gender, age and pathological type between the two groups (P> 0.05). The incidence of retinal breaks was significantly lower in the subdivision group (35.5%) than in the group (54.3%), while the rate of postoperative retinal rebleeding and postoperative visual acuity improvement was not significantly different between the two surgical approaches (P> 0.05 ). Conclusion The incidence of retinal breaks in patients in the operation group is small, and the incidence of postoperative bleeding is slightly lower than that in the membrane-removed patients. There is no significant difference between the two groups in postoperative visual acuity improvement (P> 0.05). Recommended for beginners PDR vitreous surgery should start from the membrane segmentation. (Chinese Journal of Ophthalmology, 2004,40: 439-442)